Limiting patients to only booking GP appointments one day in advance is the most effective way of reducing non-attendance, a study published in the British Journal of General Practice found.
The study, which looked at different interventions to tackle non-attendance in 25 practices, found appointments made beyond two days in advance accounted for 75% of did not attends (DNAs).
But one of the practices in the study experienced a rapid drop in its DNA rate after it changed its appointment system altogether, by reducing the maximum booking time from one month to one working day – a fall from an average DNA rate of 7.8% to 3.9% within two years.
The practice team discussed which groups of patients might be disadvantaged by this approach – namely, carers and patients with specific advocacy needs that require advance booking – and exempted them from the policy, the report said.
The researchers found this to be the ‘most effective practice intervention’ and concluded that to reduce non-attendance, ‘it appears that the appointment system needs to change, not the patient’.
Altering patient behaviour
The study compared different techniques used to bring down the rate of missed appointments in 25 GP practices in Tower Hamlets, East London, between April 2016 and March 2019.
These practices all took part in a quality improvement (QI) programme funded by Tower Hamlets CCG, which included sharing data on appointment systems and DNA rates, as well as supporting practices to make operational changes.
This generic intervention led to the average DNA rate dropping from 7% to 5.2% after two years, which is equivalent to a reduction of 4,031 DNAs per year, or an annual saving of £120,930, the report found.
Fourteen practices also tested patient behaviour interventions, such as publicising the number of appointments lost to DNAs, introducing SMS reminders, hotline and text cancellation services, or telephone reminders for those with a history of DNAs. Over 24 months, these practices saw a ‘modest additional drop’ in DNA rates, the study found.
However, the report said that most practices opted to test these interventions ‘despite being given information showing that booking delay is the major driver of DNA rates’, which suggested that ‘major changes’ to working routines are required – something that is a challenge for providers.
Changing working practices
According to the study, the practice that made the systematic change to its appointment system did so because it was facing reduced appointment capacity due to a shortage of GPs.
The researchers said this shows ‘it may take a crisis to justify taking the risks’ of changing ‘ingrained working practices’ – something the Covid-19 pandemic has demonstrated.
They concluded: ‘Forward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact.
‘In contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.’
